Successful Desensitization ofEfavirenz in an 8 -year-Old HIV-Positive Child

Abstract: Background & Aims: Allergic reaction is a common side effect of Efavirenz and drug replacement may not be an option to physicians. Here, a successful drug desensitization experiment on an 8-year-old female child over a period of 9 days is reported. Case presentation: The patient was an 8-year old female child with HIV in Kerman, Iran who had been received oral efavirenz together with lamivudine and zidovudine. The patient had showed allergic reaction in the form of skin rashes and itchy skin right one hour after the use of the medication. Since replacing efavirenz with other medications was not an option, in this case, we developed a 9- day drug desensitization strategy in which on the first day, 300 mg of efavirenz was dissolved in 10 ml water and was given to the patient. The medication was doubled every day since after. After 9 days of drug administration, the patient was successfully desensitized toward the medication. The patient was monitored for 3 months and had no problem while using efavirenz together with lamivudine and zidovudine. Conclusion: This drug desensitization protocol for efavirenz can be recommended to physicians when medication replacement may not be an option due to the lack of drug availability. Keywords: Efavirenz, Desensitization, Drug hypersensitivit

A Case Report of the Rare Disease of Pseudoainhum at Kerman Afzalipour Hospital, Iran

Abstract: Background & Aims: Pseudoainhum is a rare acquired or congenital disorder characterized by progressive development of a fibrotic band on a finger or toe until spontaneous autoamputation occurs. The various etiological hypotheses given for this disease include infectious (mycosis, mycobacteria), traumatic (plants), vascular (andysplasia), neurological (polyneuritis), and genetic (keratodermia) mechanisms. Ainhum predominantly affects black people living in west Africa, south America, and India. Case presentation: A 12 year old girl from Chahrigan Harirabad, a village near Kahnooj, Iran, with low socioeconomic status whose parents were not related, presented with autoamputated right foot toes. According to her mother she was in her usual state of good health until 1 year of age, when she developed a deep painless wound in the base of the fifth toe of the right foot. The depth of the wound progressed over time until it autoamputed. The same process happened to the 2nd, 3rd, and 4th toes of the same foot. On physical examination the pulse of the posterior tibialis artery was too weak and there was no detectable pulse of the dorsalis pedis artery. All examinations of toes of the left foot were normal. There was also a kyphoscoliosis toward the left side. The laboratory tests were normal; however, triphasic Doppler sonography showed a decreased velocity of blood flow in the distal part of the anterior tibialis artery. Conclusion: Due to the rarity of the disease and genetics being the most important contributing factor, we suggest a genetic study of this patient and her family members, regular follow up, and physical examination of the patient. We also suggest that with promotion of the level of hygiene and adequate education we can prevent further damage in this patient, as trauma and subsequent infection are the likely predisposing factors. Keywords: Pseudoainhum, Autoamputation, Dorsalis pedis artery, Anterior tibialis artery » XM

Seroepidemiology of Varicella and value of self-reported history of Varicella infection in Iranian medical students

Objectives: We conducted this study to assess the seroprevalence of Varicella zoster virus (VZV) antibodies in a group of Iranian medical sciences students that were at risk of Varicella and the value of self-reported history as a predictor of immunity. Material and Methods: 255 medical, nursing and obstetrics students who had not entered as a student or worked in a hospital from 3 different schools were enrolled in the study in 2012 (Qazvin province, Iran). Demographics and other information as well as the history of Varicella were obtained through a self-administered questionnaire. Blood samples were collected to determine the Varicella IgG levels via an enzyme-linked immunosorbent assay. A statistical analysis was performed by calculating prevalences and their 95% confidence intervals. Sensitivity, specificity, positive and negative predictive values, Cohen's kappa and positive and negative likelihood ratios of recalled history were determined. p < 0.05 was considered statistically significant. Results: The mean age of participants was 21.3±4.3 years. Seropositivity rate was 74.5%. The relationships between marital status, number of family members, and acquired VZV history with immunity against the virus were statistically significant. The overall rate of reported history was 57%. The positive and negative predictive values of self-reported history of Varicella were 91% and 47.3%, respectively. Conclusions: Immunization of students of Iranian medical sciences seems logical in the near future. Also, they should be tested for Varicella immunity regardless of the history of previous infection

Successful Desensitization ofEfavirenz in an 8 -year-Old HIV-Positive Child

Abstract: Background & Aims: Allergic reaction is a common side effect of Efavirenz and drug replacement may not be an option to physicians. Here, a successful drug desensitization experiment on an 8-year-old female child over a period of 9 days is reported. Case presentation: The patient was an 8-year old female child with HIV in Kerman, Iran who had been received oral efavirenz together with lamivudine and zidovudine. The patient had showed allergic reaction in the form of skin rashes and itchy skin right one hour after the use of the medication. Since replacing efavirenz with other medications was not an option, in this case, we developed a 9- day drug desensitization strategy in which on the first day, 300 mg of efavirenz was dissolved in 10 ml water and was given to the patient. The medication was doubled every day since after. After 9 days of drug administration, the patient was successfully desensitized toward the medication. The patient was monitored for 3 months and had no problem while using efavirenz together with lamivudine and zidovudine. Conclusion: This drug desensitization protocol for efavirenz can be recommended to physicians when medication replacement may not be an option due to the lack of drug availability. Keywords: Efavirenz, Desensitization, Drug hypersensitivit

A Critical Review of Short-Term Water Demand Forecasting Tools—What Method Should I Use?

The challenge for city authorities goes beyond managing growing cities, since as cities develop, their exposure to climate change effects also increases. In this scenario, urban water supply is under unprecedented pressure, and the sustainable management of the water demand, in terms of practices including economic, social, environmental, production, and other fields, is becoming a must for utility managers and policy makers. To help tackle these challenges, this paper presents a well-timed review of predictive methods for short-term water demand. For this purpose, over 100 articles were selected from the articles published in water demand forecasting from 2010 to 2021 and classified upon the methods they use. In principle, the results show that traditional time series methods and artificial neural networks are among the most widely used methods in the literature, used in 25% and 20% of the articles in this review. However, the ultimate goal of the current work goes further, providing a comprehensive guideline for engineers and practitioners on selecting a forecasting method to use among the plethora of available options. The overall document results in an innovative reference tool, ready to support demand-informed decision making for disruptive technologies such as those coming from the Internet of Things and cyber–physical systems, as well as from the use of digital twin models of water infrastructure. On top of this, this paper includes a thorough review of how sustainable management objectives have evolved in a new era of technological developments, transforming data acquisition and treatment.</jats:p

Nanocurcumin as an Add-on to Antipsychotic Drugs for Treatment of Negative Symptoms in Patients With Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE/BACKGROUND: It is well documented that one of the pathophysiological mechanisms of negative symptoms in patients with schizophrenia is hypofunction of N-methyl-d-aspartate receptors. This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of nanocurcumin as an adjuvant agent on psychotic symptoms, especially negative symptoms, in patients with chronic schizophrenia. METHODS/PROCEDURES: Fifty-six inpatients with stable chronic schizophrenia and predominant negative symptoms were randomized in a 1:1 ratio to nanocurcumin soft gel capsule (160 mg/d) and control groups, along with their antipsychotic regimen for 16 weeks. The efficacy of treatment was assessed by Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement scales. Extrapyramidal symptoms were evaluated by Simpson-Angus Scale and Barnes Akathisia Rating Scale. Patients were assessed at baseline and weeks 4, 8, 12, and 16 after the medication started. FINDINGS/RESULTS: No significant differences were observed in demographic or clinical variables between both groups at baseline. The nanocurcumin group showed significantly greater improvement on the negative subscale (P = 0.05), the general psychopathology subscale (P < 0.001), the positive subscale (P = 0.004), total Positive and Negative Syndrome Scale (P < 0.001), Clinical Global Impressions-Severity (P < 0.001), and Clinical Global Impressions-Improvement scores (P < 0.001) in comparison with the control group at the endpoint. Extrapyramidal symptom rating scales and Calgary Depression Scale for Schizophrenia and frequency of other adverse effects were comparable between 2 groups. IMPLICATIONS/CONCLUSIONS: The present study indicates nanocurcumin as a safe and potential adjunctive treatment strategy for treatment of primary negative symptoms of schizophrenia. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved